Medical staff and patients at the Jewish General Hospital will be using a potentially powerful new tool in the fight against the COVID-19 pandemic in the coming days — a smartphone app that will allow users to monitor their vital signs by simply staring into their phone’s screen.
The medical-grade app, developed by a Tel Aviv company in collaboration with a Montreal health technology firm, is believed to be the first of its kind in the world. Although the app was not designed with COVID-19 in mind, the Jewish General will be using it in three distinct ways during the pandemic.
First, starting as early as next week, triage nurses will use the app to screen arriving emergency-room patients for telltale symptoms of the respiratory illness. Without having to touch a patient, a triage nurse will hold a smartphone in front of a patient’s face and in less than a minute the app will measure three vital signs: heart rate, respiratory rate and oxygen saturation in the blood.
Patients with abnormally elevated heart and respiratory rates as well a low oxygen-saturation reading will be isolated immediately for further investigation.
Second, the Côte-des-Neiges hospital will use the app in its COVID-19 wards, giving it to some of the patients so they can monitor their vital signs in their negative-pressure rooms. This should result in nurses entering those rooms less frequently, which in turn will help conserve the scarce supply of gloves, masks and other personal protective equipment worn by medical staff.
Third, the app will be downloaded by some vulnerable patients in Montreal’s west end — which has reported the highest concentration of COVID-19 cases in the city — to let people monitor their symptoms at home.
The hospital is completing the testing of the app’s accuracy on-site and, given the early positive results, has shared it with the Quebec Health Ministry. The provincial government is considering introducing the smartphone technology across the province with the goal of reducing the size of a possible second wave of COVID-19 cases in the next few months.
Had the app existed widely in the general population before the pandemic struck this year, its developers say, the technology could have slowed the spread of the novel coronavirussince some infected users would have known to self-isolate at home.
Dr. Lawrence Rosenberg, executive director of the health authority in charge of the Jewish General, said the app has the potential to be what he called a game-changer.
“It should allow us to pick up people who are virus-positive but who have subtle or early symptoms that we wouldn’t be able to pick up previously until they came to an emergency room,” Rosenberg said.
Despite 21st-century advances in medical technology, governments around the world have resorted to quarantines — a measure first deployed in the 14th century — to cope with the pandemic that has killed at least 83,000 people to date. But an easy-to-use app that could be downloaded by almost anyone with a smartphone promises to at least limit the contagion.
The current strategy of locking down entire cities cannot go on indefinitely. Quebec Premier François Legault has extended the closing of non-essential businesses until May 4.
“Whether it’s May 4 — a week earlier or a week later — people will have to start coming out,” Rosenberg said. “That will be a time when having the app widely available will be useful because people can then start screening themselves for things like O2 saturation and their respiratory rate. Then (some) will either go back into isolation or go to the emergency room. But it will keep them off the street and should mitigate the second wave, in principle.”
Binah.ai, a Tel Aviv company, developed the underlying technology, which is used by the Montreal firm Carebook Technologies Inc. for the COVID-19 app. Fitness trackers like Fitbit rely on light pulses against the skin to monitor for things like one’s heart rate using PPG or photoplethysmography. The Israeli company takes this a step further with remote PPG (rPPG), with the app using a smartphone’s camera to capture the light on a person’s cheeks below the eyes.
Harnessing the power of artificial intelligence, rPPG measures how light goes through the skin beneath the cheeks into the blood capillaries. Sheldon Elman, a staff physician at the Jewish General and the chairman of Carebook, said the software engineers hope to soon add the ability to measure blood pressure.
A Montreal Gazette reporter downloaded the app and tested it on himself, observing a heart rate of 83. The Fitbit on the reporter’s wrist displayed the same number. The app worked smoothly in natural light during the day and in artificial light at night.
The technology, so far tested successfully on 13,000 people, can be downloaded on an iPhone 8 or higher and on Samsung models 7 and up. The app does not take a person’s picture or use facial recognition. The vital-sign measurements can be shared only with the consent of the patient.
Dr. Elman stressed that the app does not diagnose COVID-19 but is useful nonetheless in the context of the pandemic. One of the app’s advantages is that people can track their vital signs as often as every eight hours to notice change over time.
A resting heart rate above 100 beats per minute, a respiratory rate higher than 30 and an oxygen saturation level below 93 per cent can signal that a patient is at risk.
“We are not a screening tool for COVID,” Elman said. “We are a screening tool for vital signs, which then in certain situations can tell you whether a change in your vital signs could indicate a deterioration that could be very much COVID-related.”
Carebook, which has fine-tuned the app in collaboration with the Jewish General, has already applied to Health Canada for approval of the technology. However, Rosenberg said that given the exceptional circumstances of the pandemic, the Jewish General will roll it out shortly anyway for its purposes.
The Montreal Gazette has learned that senior officials in the government, including Health Minister Danielle McCann, have taken a keen interest in the app and are poised to make a decision on its widespread use in the coming days.